18. Memorandum from The Prison Reform
Trust
INTRODUCTION
1. The Prison Reform Trust (PRT) is an independent
charity that works to create a just, effective and humane penal
system. We inquire into the system, inform prisoners, staff and
the wider public and seek to influence government towards reform.
PRT provides the secretariat to the Parliamentary All Party Group
on Penal Affairs. Each year we publish a number of reports on
all aspects of prison life that receive widespread media attention,
inform ministers and officials and lead to changes in policy and
practice. Our expertise and experience is recognised by HM Chief
Inspector of Prisons for England and Wales. About 4,000 prisoners
and their families contact our advice and information service
each year. We jointly produce a range of prisoners' information
booklets with the Prison Service.
2. PRT is pleased to respond to the Inquiry's
request for evidence.
3. This submission primarily focuses on
the committees' request for evidence on the issue of preventing
deaths in custody. It will draw from research carried out by PRT
and information received from our advice and information line,
from regular meetings with Prison Service officials and from visits
to prisons.
4. It is crucial to bear in mind that there
is no single cause of suicide. Any suicide arises from a combination
of circumstances, and suicide in custody always includes factors
inside and outside prison.
WHAT ARE
THE MAIN
CAUSES OF
DEATHS IN
CUSTODY?
1. Overcrowding
1.1 A recent PRT publication, A Measure
of Success: An Analysis of the Prison Service's performance against
its Key Performance Indicators 2002-03, (Solomon 2003) highlighted
the fact that in 2002-03 there were 105 self-inflicted deaths
in prisons in England Wales, the highest ever recorded total for
a financial year. It represented a 40% increase compared to 2001-02
when there were 75 self-inflicted deaths. The report noted that
the rise in suicides had happened at a time when the Prison Service
was dealing with a rapidly rising prison population. During the
financial year 2002-03 it rose by nearly 3,000. At the end of
March 2003, 94 of the 138 prisons in England and Wales were overcrowded
(this means that a prison is holding more prisoners than its uncrowded
capacity, known as its certified normal accommodation level).
1.2 Responding to the report in an interview
on the BBC's Breakfast with Frost programme, the Director General
of the Prison Service, Phil Wheatley, said: "Some of that
[the rise in suicides] is because of overcrowding . . . it's just
the sheer pressure of numbers which means that we're moving people
into a local prison from the courts and then moving them out very
quickly. Large numbers entering and with staff not having sufficient
time to try to understand the individual needs of individual prisoners.
So that's part of the problem."
1.3 The critical factor that Mr Wheatley
was highlighting is what is known in the Prison Service as the
"churn", ie the movement of prisoners around the system.
Overcrowding results in people being moved much more frequently.
Within prisons a remand prisoner can go to court during the day
only to find that his or her cell has been re-assigned during
the day. The Lord Chief Justice, Lord Woolf, has said that overcrowding
is so severe that some prisoners no longer attend their appeals
because they fear that by the time they return to prison their
cells will be allocated to another prisoner (The Times June
2003).
1.4 A study by PRT and the National Advisory
Council of the Independent Monitoring Boards (the watchdogs appointed
by the Home Secretary to monitor prison conditions) entitled Prison
Overcrowding: The Inside Story found that many prisoners are
being moved around the country at short notice (Levenson 2003).
The IMB at Holloway noted: "The practice here is to ship
out, even at very short notice, however many prisoners are needed
to free up accommodation for the daily intake."
1.5 The Prison Service's Safer Custody group
has acknowledged a clear link between the rise in suicides and
the high level of movement through the prison system. Its research
has shown that 10 of the 20 establishments with the highest incidence
of self-inflicted deaths are also in the top 20 for turnover of
population (Safer Custody Group August 2003).
1.6 Overcrowding can also result in prisoners
being regularly relocated within a prison, especially when so
many prisoners in local jails are being moved to and from court
on a daily basis. A Prison Service study of suicides among women
found that repetitive cell moves was a common factor (Mackenzie,
Oram et al 2003).
1.7 PRT believes that reducing prison numbers
would have a direct impact on the number of prisoners who commit
suicide.
2. Mental health
2.1 Many prisoners have significant mental
health problems. Research by the Office for National Statistics
has found that 40% of male and 63% of female sentenced prisoners
show symptoms of at least one neurotic disorder, such as depression,
anxiety and phobias. Nearly two thirds of male sentenced prisoners
and half of female prisoners suffer from a personality disorder.
These levels of mental illness are three times higher than among
the general population (Singleton, Meltzer et al 1998).
2.2 A high proportion of prisoners have
been treated in psychiatric hospitals—According to the ONS
study one in five male sentenced prisoners and 15% of female prisoners
have previously been admitted to a psychiatric hospital.
2.3 Many prisoners have attempted suicide
before entering custody. The ONS study reveals that 20% of men
and 40% of women entering custody say they have previously attempted
suicide.
2.4 It is important to note that a higher
proportion of women prisoners than men enter prison with mental
health problems. A report by PRT, published in July, Troubled
Inside: Responding to the Mental Health Needs of Women in Prison
stated: "Given the stresses of concerns about families,
their housing and finances, and the risk of victimisation inside,
it is not surprising that the mental health of many women deteriorates
while in prison" (Rickford 2003).
2.5 The Troubled Inside report notes
that a qualitative analysis of 30 Senior Investigation Officer
Reports carried out by the Prison Service in 2002 found that problems
in mental health provision played a part in about eight of the
30 prisoner deaths. The identified difficulties related primarily
to health care accommodation, staffing levels, skill levels and
access to specialists. Health Care staff often faced serious shortfalls
in the resources they had available to treat very challenging
and complex problems.
2.6 PRT believes that there is a clear link
between the high prevalence of mental illness among prisoners
and the level of suicides. Mental health problems directly contribute
to the risk of suicide. Many prisoners who have suicidal thoughts
and those who go on to succeed in taking their own lives will
have suffered from a mental disorder.
3. Drugs, social exclusion and family ties
3.1 It is important to note that there are
the factors in prisoners' lives prior to imprisonment that increase
that person's risk of suicide. These include drug dependency,
social exclusion and weak family ties.
3.2 Drug dependency is common among many
prisoners. Over half of all prisoners say they have a serious
drug problem. Around two-thirds use illegal drugs in the year
before imprisonment—at least double the level among the
general population (Prison Reform Trust Briefing, July 2003).
3.3 Drug use in prison is extensive and
rising. All prisoners are subject to random mandatory drug tests.
The results reveal that recorded drug use increased for the first
time in 2002-03 for five years. Positive tests rose marginally
from 11.6% to 11.7%. PRT continues to be provided with anecdotal
evidence that drugs are available in most prisons.
3.4 When prisoners first enter custody many
will go through a period of detoxification. In 2001-02 there were
nearly 48,000 entrants to detoxification programmes for alcohol
and drug misuse. But concerns have been raised by HM Inspectorate
of Prisons about the uneven distribution and variable quality
of detoxification programmes, especially for prisoners who have
been dependent on crack cocaine.
3.5 Providing good quality detoxification
is critically important given the fact that one in 10 suicides
occur within 24 hours of admission to prison and almost a third
occur within the first week.
3.6 Many prisoners have experienced a lifetime
of social exclusion. This has been clearly documented by the Government's
Social Exclusion Unit in its report, Reducing re-offending
by ex-prisoners. It found that compared to the general population
prisoners are 13 times more likely to have been in care as a child,
13 times more likely to have been unemployed and 10 times as likely
to have been a regular truant (Social Exclusion Unit July 2002).
3.7 Six out of 10 men in prison and two
thirds of women have dependent children. Family relationships
can be complicated and difficult. But when entering custody maintaining
family ties and links with the outside world becomes very important
for prisoners. This is not easy for significant numbers of prisoners
who are held a long way from their homes. At the end of February
2003, 27,000 prisoners were held over 50 miles from their committal
court town and 12,500 were held over 100 miles away. Research
by PRT has found that the number of visits has fallen by a third
in the past five years, despite a more than 20% rise in the prison
population (Prison Reform Trust 2001).
3.8 Although drug abuse, social exclusion
and fractured family ties are not the main causes of deaths in
custody they are significant factors that are often prevalent
in the personal histories of those who take their own lives.
4. Staffing
4.1 Overcrowding puts staff under enormous
pressures. This means that they have less time to familiarise
themselves with prisoners and therefore less chance of identifying
prisoners at risk of suicide or self-harm.
4.2 Staff sickness is at record levels.
In 2002-03 the average level of staff sickness was 14.7 days,
well above the target of nine days. The Prison Service has not
managed to meet its target on staff sickness since it was introduced
since 1999 (Solomon 2003). At the end of March a third of all
prisons had vacancies for at least 5% of prisoner officer posts
(House of Commons, Written Answers, 20 March 2003). According
to the Prison Officers Association sickness levels among prison
officers are the highest in the public sector.
4.3 High levels of staff sickness mean that
officers have to cover the duties of their colleagues on wings
where they do not know any of the prisoners and where they need
to learn the routine at short notice. In these circumstances prisoners
who are at risk of taking their own lives are not always identified
and monitored properly.
4.4 Staff shortages also mean that prisons
struggle to maintain personal officer schemes that are designed
to provide prisoners with a designated member of staff to support
them and work through a sentence plan. This means that prisoners
do not get the support intended for them or the structure provided
by a sentence plan.
4.5 Staff shortages have been exacerbated
in recent years by a deliberate policy pursued by the Prison Service
to reduce the number of staff who are active on a wing at any
one time. The so-called performance improvement process requires
prison management to cut costs, and the primary target for savings
is in the reduction of staff numbers.
4.6 The Prison Service is also experiencing
staffing problems at senior management levels. Research by the
Prison Reform Trust has found that in the last five years a third
of all prisons have had four or more governors, or acting governors
in charge. This level of unstable and inconsistent leadership
means that staff training in suicide prevention skills and procedures
to monitor prisoners at risk of suicide can be neglected.
WHAT PRACTICAL
STEPS HAVE
ALREADY BEEN
TAKEN TO
PREVENT SUICIDES
AND SELF-HARM
IN PRISON?
1. The Prison Service's Safer Custody Strategy
1.1 The Safer Custody Group was established
in April 2001 to deliver a new Safer Custody Strategy. The Group
has a broader agenda than the Suicide Awareness Support Group
which it replaced. One of its main tasks is to develop a revised
suicide and self-harm prevention policy and to communicate and
work with other agencies. A Research and Training Group, amongst
other things, analyses deaths to ensure that lessons are learnt.
A Safer Prisons Group develops safer environment design standards,
a local prisons programme and use of technology to help suicide
prevention.
1.2 The Safer Custody Strategy is in the
process of being refined. However, its general direction is:
— to move from awareness to prevention;
— to invest more resources where the
risks are highest;
— to provide a better physical environment
for prisoners (particularly when first received into custody);
— to provide more training in mental
health and suicide prevention for front line staff in particular;
— to develop better interventions for
the management of repetitive self injury;
— to increase numbers of prisoner Listeners
in high risk prisons;
— to develop better links with other
agencies in the criminal justice system.
1.3 The Safer Custody Group is advocating
a pro-active approach, focusing on specific areas of prison practice
(rather than on targeting individual prisoners) to improve the
services provided. For example, in the context of the known risks
associated with drug dependence and mental health, one of the
proposals for Safer Local Prisons project is clinical management
of substance misuse in a dedicated unit.
1.4 A new Prison Service Order, 2700, on
Suicide and Self-harm Prevention, was published in November 2002.
PSO 2700 replaces previous guidance with mandatory requirements.
The new PSO is to be welcomed and should provide for safer, healthier
and more decent prisons provided increased prison numbers do not
undermine the best efforts of prison staff.
2. Samaritans Listener Scheme
2.1 The Samaritans operate a prisoner peer
supporter scheme in prisons, known as Listeners. These are people
selected, trained and supported by Samaritans to offer confidential
support to their fellow prisoners who may be at risk of suicide,
otherwise in crisis, or simply in need of someone to talk to.
The scheme's objectives are to assist in preventing suicide, reducing
self-harm and to help alleviate the feelings of those in distress.
2.2 The scheme is extremely positive and
PRT fully supports the work carried out by Listeners. They play
an important role in many prisons and the scheme provides prisoners
with an important opportunity to support and assist each other.
2.3 A pilot project is currently underway
to extend the ideas behind the Listener scheme to provide prisoners
with the opportunity to befriend vulnerable prisoners when they
first arrive at a jail and assist with induction and settling
into the prison regime. PRT welcomes this development as a positive
example of how prisoners can play an active role through volunteering
that raises their self-esteem and provides significant benefits
to other prisoners.
3. The transferal of Prison Service healthcare
to the Department of Health
3.1 At the beginning of April financial
responsibility for healthcare in prisons transferred over to the
Department of Health (DoH). This is the first phase in a gradual
transfer of health provision to Primary Care Trusts. It is hoped
that this will raise the standard of healthcare in prison and
so contribute to improving approaches suicide prevention.
3.2 A commitment has been made to increase
the number of mental health in reach teams working in prisons.
As of March 2003 there were 42 teams comprising over 155 staff
working with prisoners.
WHAT FURTHER
STEPS NEED
TO BE
TAKEN TO
PREVENT SUICIDE
AND SELF-HARM
IN PRISON
1. A reduction in the numbers being held
in prisons in England and Wales is imperative in order to prevent
a further rise in self-inflicted deaths. Prisoners would not be
moved around the system so often and would be able to settle more
quickly. They would also be able to maintain better links with
family and friends.
2. If prisons were not overcrowded staff
would be under less pressure and would be in a better position
to assist prisoners at risk of self-harm or suicide. Interventions
could also be based on care rather than simply on observation.
At present staff are not in a position to provide one to one support
to prisoners. The Prision Service needs to move from a culture
based on observation and risk-management to one based on care
as this could be far more effective in preventing suicides and
self-harm.
3. The Prison Service needs to stabilise
management and staffing throughout the Service so that there is
not a high turn over of staff and there is a reduction in the
level of staff shortages.
4. Court diversion schemes need to be available
across the country so that offenders who are acutely ill or at
risk of suicide can be given hospital places or treatment they
need. Unless these schemes operate effectively there will be little
hope of reducing the high numbers of mentally ill prisoners who
self-harm or commit suicide. It is estimated that there are likely
to be up to 500 patients in prison health care centres sufficiently
ill to require admission to the NHS (Reed 2003).
5. The suicide rate among remand prisoners
is particularly high. Last year 36 prisoners awaiting trial took
their own lives which accounted for more than a third of all prison
suicides. There needs to be an improvement in the conditions of,
and treatment for, remand prisoners and a reduction in the needless
use of custodial remand.
INVESTIGATION OF
DEATHS IN
CUSTODY
1. With the implementation of the Human
Rights Act 2000, the Prison Service has faced an increasing number
of calls for independent investigations into deaths in custody
in accordance with Article 2 of the European Convention on Human
Rights. Article 2 not only protects the right to life but also
requires an "independent investigation" into the death
of any person in the care of the state. At present the Prison
Service conducts its own internal investigations into suicides.
2. A recent Appeal Court judgment confirms
that the current systems in place for investigating a death in
custody are sufficient, if properly followed, to satisfy the requirements
of Article 2 (Safer Custody Group, 2002).
3. However there are two key areas where
the Prison Service may be deficient in respect of the requirements
of Article 2: firstly, the quality of the reports, which should
be detailed, thorough, and if necessary critical of the establishment
and secondly, the need for greater involvement of the next of
kin in the investigation. Legitimate family concerns need to be
addressed.
4. The Prison Service recently announced
that the Prisons and Probation Ombudsman would carry out an investigation
into a suicide at Styal women's prisoner in Cheshire where six
prisoners have taken their own lives in the last 12 months. The
Prison Reform Trust welcomes this development and believes that
the ombudsman or another independent authority should carry out
investigations in to all suicides in Prison Service custody. A
Prison Service review is currently examining extending the remit
of the Prisons and Probation ombudsman to investigate all deaths
in custody.
16 September 2003
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